Prostate Cancer

Prostate cancer occurs when cells in the prostate gland grow uncontrollably, resulting in a tumor. Since prostate glands are only found in the male reproductive system, only men can develop this type cancer. It is the second most common form of cancer in men behind skin cancer.

According to estimates, nearly 3 million men are currently living with prostate cancer in the U.S, and one in seven men will be diagnosed with the disease in their lifetime. While common, the disease is highly treatable, and when caught at an early stage, the rate of survival is very high. Most men who are diagnosed with prostate cancer will not die from the disease.

Causes and Risk Factors of Prostate Cancer

Prostate cancer is caused by mutations of genes that lead to tumor growth. These mutations might be inherited (passed on from a parent) or acquired (caused by damage to the genes). The disease only affects men.

Factors that increase your risk of prostate cancer include:

  • Age: Your risk of developing the disease increases with age, with 60% of prostate cancer cases occurring in men over the age of 65.
  • Race: Research shows that African-American and Caribbean men have a greater risk of developing prostate cancer than white men, and are more than twice as likely to die from the disease. Asian and Hispanic men have the lowest risk of being diagnosed with prostate cancer.
  • Geography: Rates of prostate cancer in men vary by location. The disease is most common in North America, the Caribbean, Europe, and Australia, with fewer cases in Central America, South America, Asia, and Africa.
  • Family history: Men with a family history of prostate cancer are twice as likely to be diagnosed with the disease than others. If your brother currently has or has had prostate cancer, you are more likely to be diagnosed with the disease than if your father has had it.
  • Gene changes: Some inherited gene mutations can lead to a higher risk of prostate cancer, but this only makes up a small percentage of all prostate cancer cases. Some mutations include Lynch syndrome, and the mutation of the BRCA1 or BRCA2 genes.

There have been many studies exploring the impact of diet, weight, smoking, and sexually transmitted diseases on prostate cancer risk. Currently, there is not enough evidence to indicate any strong links between these factors and the risk of developing the disease, but research is ongoing. Living a healthy lifestyle, avoiding smoking, and practicing safe sex by using condoms are all recommended by doctors to protect your health.

Prostate Cancer Prevention

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Men die each day from prostate cancer That's 26,730 this year — enough to fill a baseball stadium.”zerocancer.org

While many risk factors for prostate cancer cannot be controlled, such as age and race, you can take some preventative steps to lower your risk and lead a healthier life. Doctors recommend being physically active, maintaining a healthy weight, and eating a diet that includes two and a half cups of fruits and vegetables per day.

Some studies suggest that the drugs finasteride (Proscar) and dutasteride (Avodart) may lower the risk of prostate cancer. As with any drug, there may be side effects, so speak to your doctor before taking any drug to prevent prostate cancer.

Prostate Cancer Symptoms and Diagnosis

Many men do not experience symptoms in the early stages of prostate cancer. Most medical professionals recommend men of average risk begin getting screened routinely for the disease at age 50. If you are at high risk or have a family history of prostate cancer, your doctor may recommend you begin screening at any earlier age. Some men experience the following symptoms of prostate cancer:

Common Symptoms of Prostate Cancer
  • Problems urinating, such as a slow stream
  • Pain or a burning sensation when urinating
  • Increased need to urinate
  • Blood in the urine or semen
  • Pain in the hips, back, pelvis, or thighs
  • Weakness or numbness in the legs or feet
  • Loss of bladder or bowel control
  • Erectile dysfunction
  • Painful ejaculation

These symptoms are not unique to prostate cancer and can indicate other issues with the body. Since the disease is easier to treat when caught early, it’s important to speak to your doctor if you experience any symptoms of prostate cancer.

Diagnosis

Doctors use a few different tests to diagnose prostate cancer. Many cases are diagnosed at an early stage through two primary screening tests, often before symptoms start to show. These tests include:

  • Prostate-specific antigen (PSA) test: A PSA screening is the first test a doctor will perform. PSA is a protein made by the prostate, and healthy men have little of it in their blood. To examine a man’s PSA level, the doctor will perform a blood test, and will usually order a biopsy when PSA is at 4 nanograms per milliliter of blood or higher.
  • Digital rectal examination (DRE): A doctor will insert a lubricated and gloved finger into a man’s rectum to feel for abnormal size and density of the prostate. This is typically done while the man is standing and bending at the waist. The examination can cause some temporary discomfort, and may result in slight bleeding.

If these tests indicate cancer, the doctor will order a biopsy. A transrectal ultrasound (TRUS) is used to look at the prostate, and a sample of prostate tissue is extracted using a needle to be analyzed.

If cancer is present in the sample, the doctor will order further tests, like an MRI or CT scan, to determine if the cancer has spread to other parts of the body. Additionally, doctors will assign a Gleason score on a scale from one to 10 that indicates how normal or abnormal the prostate looks. Higher scores indicate a more abnormal prostate.

Stages of Prostate Cancer

The stage of prostate cancer is determined by how far the cancer has advanced. Doctors will consider the patient’s PSA levels and Gleason score, the growth of the cancer, the lymph node status, and the level of metastasis.

Prostate Cancer Stages
Stage I: The tumor may or may not be noticeable from a DRE or imaging test. The cancer has not left the prostate. The Gleason score is six and PSA is less than ten.
Stage IIA: Doctors may or may not be able to feel the tumor, and the cancer only exists in the prostate. The cancer has a Gleason score between six and seven, and the PSA is between 10 and 20.
Stage IIB: The cancer may or may not be felt by a doctor through DRE and has not spread outside the prostate.
Stage III: The cancer has spread outside the prostate and to nearby sites, but has not invaded lymph nodes or distant sites.
Stage IV: The most aggressive stage, the cancer has metastasized and spread to distant parts of the body, and likely to nearby lymph nodes.

Survival Rates and Life Expectancy

Survival rates for prostate cancer range depending on the stage of the cancer at diagnosis.

The National Cancer Institute (NCI) collects data and statistics on prostate cancer survival rates by stage, grouping cases based on where the cancer is located in the body. Local stage cases show cancer only in the prostate, while regional stage indicates that the cancer has spread outside the prostate but only to nearby organs. Distant stage is the most advanced, with cancer existing in other parts of the body and in lymph nodes.

Prostate Cancer Survival Rates
Stage5-Year Survival Rate
Local Stage (Stages I and II)99%
Regional Stage (Stage III)99%
Distant Stage (Stage IV)36%

The majority (79%) of prostate cancer cases are caught at the local stage, leading to a high probability of survival with proper treatment.

Prostate Cancer Treatments and Therapies

Men who are diagnosed with prostate cancer should consult with an oncologist and urologist to establish a course of action. Each cancer case is unique and requires an individualized treatment plan depending on the cancer’s stage and the patient’s circumstances. Treatments for prostate cancer include:

  • Active surveillance: Prostate cancer grows very slowly, so older men with localized prostate cancer may not need an aggressive treatment approach. Active surveillance consists of frequent monitoring of the cancer through PSA and DRE tests every few months. If results change and the cancer grows, more intensive treatment may be necessary.
  • Surgery: Many doctors recommend surgery if the cancer is only in the prostate. Surgery will entail removing the entire prostate and nearby tissues through a process called a radical prostatectomy.
  • Radiation: Using high-energy rays, radiation can be used to kill cancer cells in a localized area. This treatment is often used as a first option and sometimes in conjunction with other methods, like surgery. Doctors either use external beam radiation or brachytherapy for prostate cancer.
  • Cryotherapy: This procedure involves freezing the prostate to kill cancer cells by using a minimally invasive operation. Cryotherapy will kill both cancer cells and any cells nearby, and is typically only used in instances where the cancer returns after radiation treatment.
  • Hormonal therapy: Since hormones called androgens lead to prostate growth, doctors may lower androgen levels to stop the growth of the prostate. This is done either through medication or surgery, and is usually only used when other therapies are not an option.
  • Chemotherapy: The use of anti-cancer drugs through chemotherapy is employed if the cancer has spread to other parts of the body. Since chemo is not a localized treatment and attacks all cells throughout the body, it is only used in later stages of prostate cancer and if other treatments are ineffective.

As with most cancers, the best way to treat prostate cancer is to catch it early. Stage I and II prostate cancer are the easiest to treat and have a high survival rate when treated properly. If you or someone you love is showing signs of prostate cancer, talk to your doctor as soon as possible.